Evaluation of the critical care multidisciplinary units workload in relation to the patients severity of illness

the objective of this study was to evaluate the worklood in the multidisciplinary critical care units of Alexandria Main University Hospital and its relation to the severity of illness among patient admitted to these units. the study was conducted at the intensive case units [ICU I and III] of critical care department at Alexandria Main University Hospital. Sociodemographic data, diagnosis and outcome were recorded from 694 patients admitted during the three months period from 1st may to end of July 2000. The therapeutic intervention scoring system [TISS] was used to objectively quantify the intensive care services provided in the ICUs and calculate workload indices. Also acute physiology and chronic health evaluation score II [APACHE II] was used to assess severity of illness and obtain the risk of death prediction using the American APACHE II equation. TISS was the highest in haematological [38.1 +/- 7.3], neurological [36.2 +/- 8.45] and septic [35.3 +/- 7.65] patients. While APACHE II score was the highest in ostoperative [36.4 +/- 7.2], toxic [31.7 +/- 8.5] and cardiovascular [26.5 +/- 3.65] patients. A positive coefficient correlation between the two scores were found in haematological and toxic groups of patients [r= 0.52, 0.3 respectively], while no positive coefficient correlation in other systems like cardiovacular, gastrointestinal and metabolic [r= 0.21, 0.1 and 0.23 respectively]. Workload indices of night shifts in units I and III were significantly higher than morning and afternoon shifts [range: 0.34-1.23, 0.23-1.32 respectively]. The risk of death prediction using American APACHE II equation compared with the actual mortality incidence were higher in cardiovascular, neurological, traumatic and postoperative patients [t= 3.26*, 1.67, 3.31*, 0.98] while it lower than observed mortality in gastrointestinal, haematological and renal patients [t= 2.8*, 2.01* and 2.02 respectively]. severity of illness scoring is a complex issue reaching many aspects of intensive care practice. It is clear that the commonly used servirty scoring systems are robust tools for measuring the impact of critical illness. They have been extensively validated and revised and they function well in the sphere for which they were designed. Although generalizing our results to all ICUs would be hazardous, we believe that our study, population represents a reliable reflection of our specific conditions

Correlation between plasma levels of adrenomedullin, severity of illness and outcome in critically ill patients

Adrenomedullin [AM] is a newly identified mutlifunctional endogenous peptide, widely distributed in human tissues. Recent studies demonstrate that AM has powerful and characteristically long lasting vasodepressor activity and it plays a role in the pathophysiology of inflammation and its levels Increase under stress conditions. The aim of this work was to evaluate plasma levels of adrenomedullin as a marker of severity of illness and outcome in critically ill patients. The plasma levels of AM were measured in 40 patients with various forms of systemic inflammatory response syndrome [SIRS] and 10 healthy volunteers serving as control. Plasma levels of AM in SIRS, severe trauma demonstrated 1826 +/- 10.64 Fmol/ml [Mean +/- SD], in traumatic shock, it was 76.20 +/- 45.04 Fmol/ml, in severe sepsis it was 70.10 +/- 40.8 Fmol/ml and in septic shock it was 273.0 +/- 232.84 FmoI/ml. These values were significantly higher than controls [5.81 +/- 1.15]. The patients with traumatic or septic shock especially had higher levels of plasma AM than those with trauma or severe sepsis respectively. These data showed that in patients with SIRS, plasma AM levels increased in proportion to the severity of illness. In this study, as well, there was a significant difference of plasma AM levels between survivors and non survivors in septic shock. The plama AM level might seive as a useful marker for evaluating the severity of disease and as an early predictor of outcome in septic shock